1. Somatoform and Dissociative Disorders Chapter 5

2. Basic definitions Somatoform disorders –pathological concern of individuals with the appearance or functioning of their bodies when there is no identifiable medical condition causing the physical complaints Dissociative disorders –individuals feel detached from themselves or their surroundings, and reality, experience, and identity may disintegrate Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis –in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms

3. Somatoform Disorders Soma – Meaning Body –Preoccupation with health and/or body appearance and functioning –No identifiable medical condition causing the physical complaints Types of DSM-IV Somatoform Disorders –Hypochondriasis –Somatization disorder –Conversion disorder –Pain disorder –Body dysmorphic disorder

4. Somatoform Disorders Hypochondriasis –severe anxiety focused on the possibility of having a serious disease –shares age of onset, personality characteristics anf running in families with panic disorder –illness phobia vs. hypochondriasis –60% of patients with illness phobia develop hypochondriasis –1% to 14% of medical patients –treatment usually invoves cognitive-behavioral therapy and general stress management treatment (gain retained after 1 year follow-up)

5. Somatoform Disorders Causes of hypochondriasis

6. Somatoform Disorders Somatization disorder –Briquet’s syndrome (100 years ago) –patients have a history of many physical complaints that can not be explained by a medical condition, the complaints are not intentionally produced –20% of patients in primary care setting –develops during adolescence (majority women) –may be connected to Antisocial personality disorder –difficult to treat (reassurance, stress reduction, more adoptive methods of interacting with family are encouraged)

7. Somatoform Disorders Conversion Disorder –Physical malfunctioning without any physical or organic pathology –Malfunctioning often involves sensory-motor areas –Persons show la belle indifference –Retain most normal functions, but without awareness of this ability –Statistics Rare condition, with a chronic intermittent course Seen primarily in females, with onset usually in adolescence Not uncommon in some cultural and/or religious groups

8. Somatoform Disorders Conversion disorder (cont.) –Freudian psychodynamic view is still popular (anxiety converted into physical symptoms) –Emphasis on the role of trauma (stress), conversion, and primary/secondary gain –Detachment from the trauma and negative reinforcement seem critical –Different from factitious disorder (intentional) –Treatment Similar to somatization disorder Core strategy is attending to the trauma Remove sources of secondary gain Reduce supportive consequences of talk about physical symptoms

9. Somatoform Disorders Body Dysmorphic Disorder –Preoccupation with imagined defect in appearance –Either fixation or avoidance of mirrors –Previously known as dysmorphophobia –Suicidal ideation and behavior are common –Often display ideas of reference for imagined defect –Statistics More common than previously thought Usually runs a lifelong chronic course Seen equally in males and females, with onset usually in early 20s Most remain single, and many seek out plastic surgeons

10. Somatoform Disorders Body Dysmorphic Disorder (cont.) –Causes Little is known – Disorder tends to run in families Shares similarities with obsessive-compulsive disorder –Treatment Treatment parallels that for obsessive compulsive disorder Medications (i.e., SSRIs) that work for OCD provide some relief Exposure and response prevention are also helpful Plastic surgery is often unhelpful

11. Dissociative Disorders Derealization –Loss of sense of the reality of the external world Depersonalization –Loss of sense of your own reality 5 types –Depesonalization disorder –Dissociative amnesia –Dissociative fugue –Dissociative trance disorder –Dissociative identity disorder

12. Dissociative Disorders Depersonalization disorder –Severe feelings of depersonalization dominate the individual’s life and prevent normal functioning –It is chronic –50% suffer from additional mood and anxiety disorders –Cognitive profile (cognitive deficits in attention, STM, spatial reasoning, perception (3D))

13. Dissociative Disorders Dissociative Amnesia –Inability to recall personal information, usually of a stressful or traumatic nature –Generalized vs. selective amnesia Dissociative Fugue –Sudden, unexpected travel away from home, along with an inability to recall one’s past (new identity) –Occur in adulthood and usually end abruptly

14. Dissociative Disorders Dissociative trance disorder –Altered state of consciousness in which the person believes firmly that he or she is possessed by spirits; considered a disorder only where there is distress and dysfunction –Trance and possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that context –Only undesirable trance considered pathological within that culture is characterized as disorder

15. Dissociative Disorders Dissociative Identity Disorder –Formerly multiple personality disorder –Many personalities (alters) or fragments of personalities coexist within one body –The personalities or fragments are dissociated –Switch (transition form one personality to another, includes physical changes) –Can be simulated by malingers are usually eager to demonstrate their symptoms whereas individuals with DID attempt to hide symptoms –Very high comorbidity –Prevalence about 3%

16. Dissociative Disorders Dissociative Identity Disorder –Auditory hallucinations (coming from inside their heads) –97% severe child abuse –Extreme subtype of PTSD –Onset – approximately 9 years –Suggestible people may use dissociation as defense against severe trauma –Real and false memories –Temporal lobe pathology (out of body experiences)

17. Dissociative Disorders Treatment –Dissociative amnesia and fugue Get better on their own Coping mechanisms to prevent future episodes –DID Reintegration of identities Neutralization of cues Confrontation of early trauma hypnosis